“Family Glitch” Update
Covered California Subsidies if your
Employer offers “Affordable Health Coverage?”

Do you or your spouse have (Family Glitch) Employer Coverage Available?

• New Family Glitch Rule!    ^CMS
  • You could enroll in the  affordable  9.96% HealthCare.gov**   Covered CA Affordability Calculator  job-based coverage,
    • while your spouse  APTC/CSR Subsidy -eligible family members enroll in a Covered CA plan.
      • Get Instant Quotes!  
  • keep in mind that:
    • This may mean they need to meet multiple deductibles and would have separate out-of-pocket maximums for each policy.
    • The separate plans may have different provider networks and coverage for prescription drugs.
    • Mus update your Covered CA Application   ^{Agent Broker FAQ} *
• More information for  newly eligible for savings  (Offers of Employer Coverage) on Covered CA  plans?
  • Special Enrollment Period (SEP) if your  job-based coverage affordability changes outside of the annual Open Enrollment Period?  CMS *
• Family Glitch Covered CA Tool Kit
• Navigating the Family Glitch Fix: Hurdles for Consumers with Employer-sponsored Coverage  KFF
• 10 Quick Facts About the New IRS Final Health Premium ‘Family Glitch’ Regs
• Federal  Register    –    36 B
• Our webpage on Covered CA Subsidies…
• Get Instant Quotes!  

FAQ?

The definition of Household Income & Taxpayer Family 

#Household.income means ^{Code of FEDERAL Regulations – IRS Income Taxes – 1.36B 1 – (e) …(1)}

(d) … A taxpayer’s family means the individuals for whom a taxpayer properly claims a deduction for a personal exemption under section 151 for the taxable year.

Family size [Medi-Cal Household Size Flow Chart ♦ Blog – Insure Me Kevin.com] means the number of individuals in the family. Family and family size may include individuals who are not subject to or are exempt from the penalty [mandate] under  §5000 A  (f)  (1) for failing to main

Minimum Essential Coverage  which includes most Group Employer Plans

IRS Interactive Tool says OK see video

Affordability and minimum value.

Even if you had the opportunity to enroll in coverage offered by your employer that qualifies as MEC, [Minimum Essential Coverage  which includes most Group Employer Plans ]  you are considered eligible for an employer-sponsored plan (and cannot get the PTC [subsidies] for your coverage in a qualified health plan) only if the employer-sponsored coverage is affordable (defined later) and the coverage provides minimum value (defined later).

Your tax family  members may also be unable to get the PTC for coverage in a qualified health plan for months they were eligible to enroll in employer-sponsored coverage offered to them by your employer but only if the  coverage qualifies as MEC and was affordable and provided minimum value for you. In addition, if you or your family member enrolls in the employer coverage that qualifies as MEC, the individual enrolled cannot get the PTC for coverage in a qualified health plan, even if the employer coverage is not affordable or does not provide minimum value  ^{IRS Publication 974 page 11} *